PFI2016-00150 ,t CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12016-00150
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 07/19/2016
Parcel: SEG665
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace bad-order T-body splices in 4 vaults
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
LINDA OTT
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-612-6093
Total $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant Not Present
t
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12016-00150
Type: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Utilities 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The
spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited
and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up
and suspension of work to accomplish clean-up.
PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work,effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Utilities 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services
Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area.Traffic control devices,flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m.to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole
before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at
the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI Utilities 14-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads,ditches, etc.)as may be necessary, as determined by
the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert
Phone#>, to establish a preconstruction meeting.
PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit. Ken Fisher 503-816-6146 or Kenny@tigard-or.gov
PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan
and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and
provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and
specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work
performance.
PFI_Utilities 19-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners,and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice
Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have
authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The
applicant shall notify the City Inspector, in writing, of any/all assignment changes.
PFI_Utilities 21 -OTHER Applied Notice
RECEN't
City of Tigard MA 18 201-
PUBLIC WORKS—ENGINEERING CFYbRjWORDER# M2125653
PI Public Facility Improvement j' FI) Permit
DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL
Check one: 8 Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS
Detailed description: PGE-Replace bad-order T-body splices in 4 vaults. B Minor work in right-of-way
(sidewalk repair,curb cut,street
opening,etc.)requires:
•Application form,completed
and signed
•Submit one(1)copy of scaled sketch
Property address/location(s): 14212 SW Barrows Rd. of the proposed work to be done
Tigard OR 97223 •Submit one(1)copy of traffic
control plan
—OR—
Applicant's name: Linda Ott for Ken Spencer(PGE Engineer) E] Substantial project work requires
PP above items and professional
Address: 10800 SW Avery St. engineered plans for:
•Street widening
Ci /state: Tualatin OR Zip: 97062 •Subdivision infrastructure
Phone: 503.612-W93/503-672"5487 Email: t&dsupportayery@pgn.com •Main utility line extension:
- Storm Drain,Sanitary—Tigard
- Water—Tigard Water Service
Contractor's name: PGE Area(includes Durham,King City
CCB#: Expiration: and a portion of unincorporated
Washington County)
Address:
City/state: Zip: DELIVER APPLICATION TO:
City of Tigard
Phone: Email: Planning/Engineering
13125 SW Hall Blvd.
Engineer's name: Tigard,OR 97223
Applications for"minor work in right-of-way"
Address: only may be emailed to:
City/state: Zip: rowpermits a tiga� rd-or.gov
Phone: Email:
FOR STAFF USE ONLY
/ Irl
1� Q—�/
Estimated value of work (within the public right-of-way): $0 CaseN1.: /�C
Application submittal fee:
Is work related to a LAND-USE DECISION? Q Yes ❑■ No Application accepted:
If so,please specify (MLP, SDR, SUB,etc.) case#: By: Date: W/le/Z41
Is work related to a BUILDING PERMIT? p Yes 8 No Application reviewed:
If so,please specify(BUILDING PERMIT)case#: By: 1C.R'ri tti Date: ')-14-t4
Q / Applicant nfied:
By: Date:
_ I:\NRp1H\Masters\Land Use Applications Ree 07/16/2014
City of Tigard • 13125 SW Hall Blvd. Tigard,Oregon 97223 www.dgard-or.gov • 503-718-2421 • Page I of 4
APPLICANTS
NOTE: Person specified as "Applicant"shall be designated "Permittee" and shall provide financial assurance for work.
*When the owner and the applicant arc different people,the applicant must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written
authorization with this application.
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate anv deed restrictions that may be attached to or imposed upon the subject_property.
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan, attachments,and exhibits transmitted herewith, are true;and
the applicants so acknowledge that ani,permit issued,based on flus application,may be revoked if it is found that an),such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria, and understands the
requirements for approving or denying the application.
SIGNATURES of each owner of the subject property required.
Dy,1111y 1,111 6y LINOA OTT
LINDA OTT OmaEi TLINDAOTT@P N COMB USENERA Linda Ott 7-19-16
Date.2016 02.19 09 22.39-0TW
Applicant/Authorized Agent's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of 4
DEVELOPMENT ENGINEERING FEES
1. Public Facility Improvement(PFI) Permit:
Part 1: Required submittal fee$300.00
Part 2: All non-water system improvements
Engineer's estimate X 5% (less$300.00 submittal fee)
Engineer's estimate X 2%Plan Review
Part 3: All public water system improvements
Engineer's estimate X 12%
Total Permit Fee = Part 2 + Part 3
PFI Permit Fee Exemptions:
There will be no permit fee charged,or assurance required for the following types of work:
• Sidewalk or driveway repair(less than 20 lineal feet)
• Relocate or replace mailbox
• Ditch cleaning that does not involve regrading.
• Weephole repair
• Curb repair or replacement (less than 20 lineal feet)
• Lawn sprinkler system installation or repair
• Street tree pruning or planting
• Planter strip landscape maintenance
• Test wells
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4
SAMPLE SKETCH:
Edge of Pavement
I `4— Ditch —�
Streetlight I — ----------- —r—•—
►! I Rafrm nnii
1 �
I I �
I
I
I Existing House
all
I Existing 1
�1 I ,tI ■ Driveway
al �I I 1
CI w I • •
I
� 1
3 I o�
al I ave'
G, I
o ■
Existing Shop �
I�
Powerpole I Y d
I I I--------7rop95ne-----------
� I R\l
i I I Fire Hydrant(FH)
I � I
Scale: 'I"=30'
� I I
I I I
� I I
� � I
MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable):
North arrow Property lines &dimension Slope of property
Street& street name(s) Existing building,structures Utility& street light poles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water, storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - wwwtigard-or.gov - 503-718-2421 - Page 4 of 4
M2125653 — Barrows Rd. — City of Tigard
Diversion into. a Continuous t_eft:Tums Lane - Diagram 4301
A Note: PGE to
notify City of
* Tigard 24 hours
LA prior to actual
work dates.
tm am
Existing Vaults:
PmudlmvwNm 723/C11-33C located
Wm fm QlaffM
heart# approx. at 14160 SW
Jim /
Barrows Rd. and
724/C11-33C located
approx. at 14130 SW
Rarrnwc Rrl
f� 0
i LPA
It
L122-
I�
ISI A
i
I I
t -
Sign Spacing and Buffer Lengths(feet) I I
Posted S acina Between Signs Buffer
Speed A B C Space
20 50
25 100 100 100 75
30 100
40 350 350 350 125 150 Chapter 6
45 180
50 500 500 500 210 v
55 12so NORTH
n
VT- APf
WR CHECKLIST
ITEM YES COMMENT
36 HCJMGEB
/ 300M
l VT-598 BACKHOE
� PGF TRENCH
dft Replace T-body splices on �_ - x
sets of AI;C-750 AL UP 1 l OCTA
1\ STAKNG
--- ------ W cables. , FIAGGNG
1163 `, HEEIRIA
� unDxur
1183 1e31 1 1,M635y 0 ^
_ 5
1 C77531! 118450 PRVM *&"v
11 1'18550 11 _ AWN rRAFHC rLw .^
C 7S 83084PC�1 ti .` t1685y 7__ 4 'wr7 0u1SNEET X sA.,538
VT 1 5 W _5j-CIAVR
YT-11
t1 I��1 11 Location Map work Location SIRn�
117151.. nuiGowh
Ga
117733 17 ( VT-599 CONTACT
1117 Replace'r-body splices on one COAPANY «
Tigard 37972 set of ABC-750 Al.UP cables. DATE 11�L
/ ATTENTION. CALL 871 BEFORE YOU DIG
OREGON LAW REQUIRES YOU i0 FOLLOW RULES ADOPTED • -''S
T
HINK
BY THE OREGON UTILITY NOTIFICATION CENTER. ,
� THOSE RULES ARE SET FORTH IN OAR 952-001-001( A
4140! 4130 l THROUGH 952-007-0090.YOU MAY OBTAIN cOR1E5 OF
t5D THE RULES BY CALLING THE OREGON UTILITY
P 141 4130 1 NOTIFICATION cmmx AQA%v"T10N 0 (505-T3R-1987)
�__ J1141 3II.�7 TO REQUEST Un1111'LOCATES CAII THE OREGON/` 40 Reay Ykan below.
__ylt: VT�2/ F _ UTILITY NOTIFICATION CENTER 811 AT LEAST Call bRh,e d
a4 14 2 BUSINESS DAYS PRIOR TO EXCAVATION. Y" �'
' 7 14196 PR314150 $ PGE CONSTRUCTION DRAWING
442# 84 Open VT-724 SDP"FNG REVIEW: AS13UILT BY DESIGNER:
e BBi 1 001141 141 01411014f 101 Replace T-body splices on p-ne AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
i 1 This document accurately rep-emit FIELD co str fin
D614407 set of ABC-750 AL UPcables.
1 Foreman: _ Date.
t / 14 0 14114178141 8 11 GF: Date:
e ff�itli DATE: 71,2116 SCALE. WA ACCOUNT:59/000} AWO:3000000476 NO.2125653
1417214 4 A 50 36253 4—au TITLE PGE-Replace BIO T-body splices in 4 Vaults
VT-72 1 t1 72 1418014180 ftAt�2 ` CIRCUITMW'Yayhill-13 kV s�
t tXn
GE
LOCAT.Barrows Rd.n/o Walnut St.
VT-723 ` DESCRIPTION Replace B/0 T-body splices in VT 598,599, 723,&724
Replace T-body splices on one
BEAVEHToN W rnCli-33C IVR
1 DF 1
set of A BC-750 AL UP cables. IBTE cREw R DESIGN BY ENONE W3) DRAWN RY
2tr3 SW rBYPO fIR Ken Spencer 672.5187. n/e
9FAVERTON.OR 97006 CO PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED